Self-Management of Postnatal Hypertension

Cairns, A; Tucker, Katherine L.; Leeson, Paul; Mackillop, Lucy; Santos, Mauro; Velardo, Carmelo; Salvi, Dario; Mort, Sam; Mollison, Jill; Tarassenko, Lionel; McManus, Richard J

doi:10.1161/hypertensionaha.118.10911

Cited by 99 publications

(104 citation statements)

References 27 publications

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“…The same research team subsequently published results of a feasibility trial of women’s self-management of BP 29. Ninety-one (49%) of 186 women approached from 5 NHS units who had gestational hypertension or pre-eclampsia which required postnatal antihypertensive management were recruited and randomised to self-management (n=45) or usual care (n=46).…”

Section: Resultsmentioning

confidence: 99%

Postnatal care following hypertensive disorders of pregnancy: a qualitative study of views and experiences of primary and secondary care clinicians

et al. 2020

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ObjectivesTo explore clinicians’ views and experiences of caring for postnatal women who had hypertensive disorders of pregnancy (HDP), awareness of relevant National Institute for Health and Care Excellence (NICE) guidance to inform their postnatal management, the extent to which NICE guidance was implemented, barriers and facilitators to implementation and how care could be enhanced to support women’s future health.DesignA qualitative study using semistructured interviews. Thematic analysis was used for coding and theme generation.SettingFour National Health Service maternity units and three general practice clinics in South-East and South-West London.ParticipantsA maximum variation, purposive sample of 20 clinicians with experience of providing postnatal care to women following HDP.ResultsFour main themes were generated: variation in knowledge and clinical practice; communication and education; provision of care; locus of responsibility for care. Perceived barriers to implementation of NICE guidance included lack of postnatal care plans and pathways, poor continuity of care, poor antihypertensive medication management, uncertainty around responsibility for postnatal care and women’s lack of awareness of the importance of postnatal follow-up for their future health. Some clinicians considered that women were discharged from inpatient care too soon, as primary care clinicians did not have specialist knowledge of HDP management. Most clinicians acknowledged the need for better planning, communication and coordination of care across health settings.ConclusionsEvidence of longer term consequences for women’s health following HDP is accumulating, with potential for NICE guidance to support better outcomes for women if implemented. Clinicians responsible for postnatal care following HDP should ensure that they are familiar with relevant NICE guidance, able to implement recommendations and involve women in decisions about ongoing care and why this is important. The continued low priority and resources allocated to postnatal services will continue to promote missed opportunities to improve outcomes for women, their infants and families.

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Section: Resultsmentioning

confidence: 99%

Postnatal care following hypertensive disorders of pregnancy: a qualitative study of views and experiences of primary and secondary care clinicians

et al. 2020

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“…A pilot RCT (SNAP-HT) was conducted in women with hypertensive disorders of pregnancy (HDP) postpartum, comparing a novel self-management intervention, comprising HBPM with self-adjustment of antihypertensive medication supported by telemonitoring, with usual care (1). Women aged ≥18 years, with gestational hypertension or pre-eclampsia, requiring antihypertensive treatment, were eligible.…”

Section: Methodsmentioning

confidence: 99%

“…Contribution to the literature In the randomised trial, those self-managing had consistently lower diastolic blood pressure to six months postpartum (1). This mixed methods study provides compelling adjunctive information about possible explanations for the success of self-management;…”

Section: Introductionmentioning

confidence: 93%

“…downloaded from HBPM monitor at the end of the study; data available for 33/34 participants Abbreviations: C = control; 95% CI = 95% confidence interval; I = intervention; SD = standard deviation [1] Five questions were asked, however data relating to impact on relationships is not presented here, as there was a systematic error by one of the two interviewers in how this question and answer scale was presented.…”

Section: Ethics Approval and Consent To Participatementioning

confidence: 99%

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Implementing self-management: a mixed-methods study of women’s experiences of a postpartum hypertension intervention (SNAP-HT)

Cairns

Tucker

Crawford

et al. 2020

Preprint

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Background Self-management strategies are effective in a number of medical conditions; however, implementation studies have demonstrated adoption into clinical practice can be problematic. The process of implementation was explored during a pilot randomised controlled trial evaluating postpartum blood pressure self-management, in women with medicated hypertensive disorders of pregnancy. Methods A mixed methods study using semi-structured interviews with a qualitative and a scored (quantitative) component were undertaken as part of a pilot randomised controlled trial (SNAP-HT) in postnatal women with medicated gestational hypertension or pre-eclampsia. Women were randomised to usual care or blood pressure self-management. Self-management entailed daily home blood pressure monitoring and automated medication reduction via telemonitoring. Women from both groups optionally consented to participate in audio-recorded interviews, at four weeks and six months postpartum. Interview questions were developed to explore the proposed benefits of self-management and the constructs of Normalisation Process Theory. Participants provided a score (Likert scale 1-5) for each question and were encouraged to expand upon these answers through further discussion. The interviews were transcribed and analysed using the framework approach. Results Sixty-eight women, 34 from each randomised group, completed at least one audio-recorded interview. Several overarching themes emerged from analysis of 126 interview transcripts: control; convenience; confidence, communication and knowledge; concern; constraints; and components of the intervention. In the scored component of the analysis, both groups reported feeling more in control of their condition postpartum compared to during pregnancy, more so in those self-managing at both four weeks and six months: adjusted differences 0.6 (95% confidence interval (CI) 0.2 to 1.1) and 0.7 (95% CI 0.3 to 1.2) respectively. Conclusions Interviews and quantitative data showed that self-management enhanced women’s sense of control, and improved their blood pressure-related anxiety. Prior to taking part, a few women anticipated that home monitoring might increase anxiety, but stated that it had the opposite effect. Self-management was perceived as more flexible, reactive and as enabling more targeted down-titration of medication. These data provide considerable support for blood pressure self-management postpartum, and reinforce the effectiveness of the intervention used in this study. Trial registration Prospectively registered with ClinicalTrials.gov on 07/01/2015 (NCT02333240) https://clinicaltrials.gov/ct2/show/NCT02333240.

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“…Despite its importance, there is limited evidence to support how to use antihypertensive therapy postpartum 27 . One trial found that HBPM and postnatal down-titration of antihypertensives improved BP control 28 . The most commonly used antihypertensives, and most others, are acceptable for use when breastfeeding 29 .…”

Section: Measure Bp Postpartum On Days 3-6 After Hypertensive Pregnancymentioning

confidence: 99%

Pregnancy hypertension diagnosis and care in COVID‐19 era and beyond

Magee

Khalil

Dadelszen

2020

Ultrasound in Obstet & Gyne

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Self-Management of Postnatal Hypertension

Abstract: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02333240.

Cited by 99 publications

References 27 publications

Postnatal care following hypertensive disorders of pregnancy: a qualitative study of views and experiences of primary and secondary care clinicians

Postnatal care following hypertensive disorders of pregnancy: a qualitative study of views and experiences of primary and secondary care clinicians

Implementing self-management: a mixed-methods study of women’s experiences of a postpartum hypertension intervention (SNAP-HT)

Pregnancy hypertension diagnosis and care in COVID‐19 era and beyond

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